To verify a disabling impairment, look for the most recent favorable medical determination
in file, e.g., SSA-831-U3, SSA-833-U3 or SSA-899-U2. This may or may not technically
be a CPD. Take the following steps to determine what action is needed to entitle an
individual or to refer a case to the DDS.
1. Individual enrolls during IEP
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a.
If an individual enrolls during the IEP, find them disabled for Premium-HI if the
following conditions are met:
-
•
Favorable medical determination completed within past 2 years (for EPE /extended Medicare
or medical CDR) AND
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•
No past due scheduled CDR diary.
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•
Individual alleges same impairment(s) that were present and documented at time of
favorable medical determination.
-
b.
Prepare an SSA-831-U3 (DI 40510.175) and route the folder to the appropriate technician for enrollment action prior to
notice preparation.
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c.
Request the typist to send the individual a permanent award notice per Exhibit 2 in
DI 40510.185.
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d.
If there is a past due medical improvement expected (MIE) CDR diary, instruct the
typist to send an interim award notice per Exhibit 3 in DI 40510.185, and forward case to the DDS under cover of an SSA-847-U3 for immediate CDR per DI 43535.025. Check blocks l.b and block 3 “Other”, and annotate the form “Section 6012 - Premium Medicare
case.”
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e.
If there is a past due medical improvement possible (MIP) or medical improvement not
expected (MINE) diary or more than 2 years since the last favorable medical determination was done, conduct
new MFR per DI 40510.155.
2. Individual enrolls during GEP
If an individual enrolls during the GEP, follow DI 40510.150C.1. above.
3. Individual enrolls during SEP
If an individual enrolls during SEP, follow DI 40510.150C.1. above.